In a prior post, I wrote about how Secretary Kennedy revoked the Richardson waiver. It stated that “[e]ffective immediately, the Richardson Waiver is rescinded and is no longer the policy of the Department. In accordance with the APA, “matters relating to agency management or personnel or to public property, loans, grants, benefits, or contracts,” are exempt from the notice and comment procedures of 5 U.S.C. 553, except as otherwise required by law.”
I wrote that as a consequence, “a lot of visibility and opportunity to comment on things that affect vendors and providers alike very well could close. Specifically, the Medicare Physician Fee Schedule, Conditions of Participation for Medicare and Medicaid, the Inpatient Prospective Payment System, and modifications to Part C (Medicare Advantage) and Part D (covered prescriptions) are all matters that relate to public benefits and contracts. Each of these has a variety of different influences. For example, the SCRIPT standards for e-prescribing are often regulated in the Part D regulations. The Merit-based Incentive Payment System and measures relating health information exchange, patient portals, and registry reporting – are regulated in the Medicare Physician Fee Schedule.
I am glad to provide an update that for now, HHS continues to appear to apply the normal rulemaking process to its fee schedules. Notably, the Hospital Inpatient Prospective Payment System for Acute Care Hospitals and Long Term Care, Inpatient Psychiatric Facilities Prospective Payment System, Inpatient Rehabilitation Facility Prospective Payment System, and the Prospective Payment System for Skilled Nursing all got proposed rules, which will formally be published in the Federal Register on April 30, 2025. You can find this all at federalregister.gov under Special Filing.
The rulemaking appears to have what I referenced above, which is great news. The hospital rule has the usual changes to the Medicare Promoting Interoperability Program . . . for hospitals. There are modifications to the electronic health record reporting period, revisions to measures (notably security risk analysis), the SAFER guideline measure, the clinical data exchange objective, further incorporation of TEFCA (which appears to have survived DOGE cuts), scoring methodology, quality measure modifications, and more. All of the “fun” things industry heads have been commenting on since the passage of the HITECH Act appear to be there.
On the inpatient side, we now have a few answers on what the biggest health IT programs will look like next year. We know TEFCA is still standing, for now. We know certified technology is still standing for now (like I predicted here). The Medicare Physician Fee Schedule is still pending, and we will start to see the shape of the ambulatory health IT environment then as well. It’s time for policy wonks to brush off their pens for the comment process that I know they have all come to love and enjoy.
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